Ranjit Sondhi, the trust's chief executive, made it clear officials were looking at "learning lessons" from the private sector.

He told the board: "The NHS is a precious asset which it has been seen to be for many years and many people would feel poorer if we didn't have a national health service, but the public sector is not the only sector.

"We're not bound by any particular model and we will use our discretion and intelligence to choose what models of care would be best."

A report by Sarbjit Basi, director of service development, says there is "growing interest in primary care as a future market for a number of non-health organisations" and franchises could see "faster rates of list size or service growth".

Chairman Dr Sandy Bradbrook told the meeting the trust was "determined" to bring about "significant change". The system was, he said, "not quite broke but it's not right".

"We're determined to bring about a process where there is significant change to bring about a wider range of primary care services and deliver better public health, but we can only do that if we take a wider view," said Dr Bradbrook. "We wish to work with existing GPs. However the national contract does not give us the lever to do so and I suspect it will never go as far as we need."

He added: "It's not quite broke but it's not right and that's what patients are telling us.

"So if a GP says everything is okay, he or she has clearly not been listening to patients."

Last night Councillor Deirdre Alden (Con Edgbaston), who is not on the trust but chairs the city council's health scrutiny committee, claimed the plans were effectively "an admission of failure".

"This strategy suggests HoB believe the NHS can't provide the best possible care, which I find disgusting," she said. "This definitely sounds like privatisation of the NHS and if the Tories had done this Labour would be jumping up and down.

"There appears to be no cap on what kind of businesses can become franchisees, so how will HoB decide who can run one? I would call that an admission of failure if they think this is the best way forward."

Coun Alden added that if, as the trust plans, franchises are given additional responsibilities such as mental health and supporting patients with learning disabilities it would create "huge potential for confusion".